1. Heart Surgery Georgia Baptist College of Nursing NUR 351 Critical Care Nursing Dr. Kathy Plitnick

2. Coronary Artery Bypass Surgery  Definition Surgical revascularization procedure Restores blood flow to ischemic heart  Goals Relieve symptoms Improve quality of life

3. Indications for Surgery  Intractable Angina  Left main stenosis  Unsuccessful PTCA, thrombolytics  VSD  Risk Factor Modification

4. CABG Procedure  Midline sternotomy  Anticoagulation  Cardiopulmonary bypass  Hypothermia induced  Aortic cross-clamping – Cardioplegia  Graft retrieval  Wean from CPB  Internal defibrillation  Rewarming – Heparin reversal

5. Cardiopulmonary Bypass  Provides bloodless operative field  CPB machine Venous reservoir, filters, oxygenator, heat exchanger, roller pump, sensors  Physiologic Variables Hemodilution Hypothermia Hemodynamics

6. Complications of CPB  Coagulation altered  RBC’s damaged  Increased capillary permeability  Microembolism  Increased SVR  Alteration in carbohydrate metabolism

7. Post-operative Complications  Myocardial infarction  Low cardiac output state  Hemorrhage  Cardiac tamponade  Dysrhythmias  Thrombotic/embolic complications  Respiratory complications  Coagulation problems

8. Post-operative Complications  Renal dysfunction  Fever/infection  Altered CNS

9. Nursing – Preoperative Care  Psychological preparation Reduce anxiety Teaching  ICU environment  Incisions & dressings  Awakening from anesthesia  Expected discomfort  Appearance  Postop respiratory care  Visiting hours

10. Nursing – Postoperative ICU Care  Ventilation and Oxygenation  Hemodynamics Regulate HR, rhythm, BP, CO  Chest drainage & Bleeding  Urine output  Temperature regulation  Neurological status  Postoperative pain